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复发性心脏瓣膜病再次外科治疗效果及其相关因素(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第3期
页码:
375-378
栏目:
临床研究
出版日期:
2011-05-12

文章信息/Info

Title:
Reoperation for recurrent cardiac valve disease
作者:
陈文生; 段维勋; 俞世强; 张金洲; 郑奇军; 王红兵; 易定华
第四军医大学西京医院心血管外科，陕西 西安 720032
Author(s):
CHEN Wen-sheng;  DUAN Wei-xun;  YU Shi-qiang;  ZHANG Jin-zhou;  ZHENG Qi-jun;  WANG Hong-bin;  YI Ding-hua
Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
心脏瓣膜病; 复发性; 再手术; 瓣膜替换术; 瓣膜成形术; 回顾性分析
Keywords:
recurrent cardiac valve disease;  reoperation;  cardiac valve replacement;  valvuloplasy;  retrospective reviewing
分类号:
R542.5
DOI:
-
文献标识码:
A
摘要:
目的:回顾性分析对二尖瓣闭式扩张术、瓣膜成形术、瓣周漏、人工机械瓣功能障碍、生物瓣衰坏等原因引起的复发性瓣膜病变进行再次手术的效果和相关因素。方法： 复发性瓣膜病患者331（男143，女188）例，年龄12～73(46±12)岁，两次手术间隔时间2月～25(17±8)年。其中二尖瓣闭式扩张术后再狭窄143例，二尖瓣或主动脉瓣成形术后瓣膜病变复发53例，生物瓣衰坏32例，瓣周漏26例，换瓣术后其它瓣膜病21例，人工瓣膜替换或瓣膜成形术后心内膜炎17例， Ebstein畸形矫治术后三尖瓣关闭不全15例，人工瓣膜机械功能故障9例，室间隔缺损修补术并行瓣膜成形术后心内膜炎7例，完全或部分性心内膜垫缺损和矫正性大动脉转位术后二尖瓣或三尖瓣关闭不全6 例，二尖瓣球囊扩张术2例。再次手术方式为二尖瓣替换术，主动脉瓣替换术，二尖瓣和主动脉瓣替换术，三尖瓣替换术，瓣周漏修补术及三尖瓣成形术等。结果： 全组共死亡27例，占8.2％，早期主要死亡原因为低心排出量综合征、室性心律失常、多脏器功能衰竭、左心室破裂、感染性心内膜炎、肾功能衰竭。随访259例，随访期6月～21（10±7）年，心功能恢复至Ⅰ～Ⅱ级189例。复发性心脏瓣膜病再次手术的危险因素包括术前心功能差、重要脏器功能不全、急诊手术、主动脉阻断时间和体外循环时间长等。结论： 针对再手术相关的危险因素进行积极防治，适时而妥善的外科手术和围手术期处理仍可获良好效果。
Abstract:
AIM:To retrospectively review the experience of valve replacement after closed mitral commissurotomy, valvuloplasty, perivalvular leakage, prosthetic valve obstruction and dysfunction of bioprosthetic valve in 331 patients. METHODS: Three hundred and thirty-one patients (143 males and 188 females) with ages ranging from 12 to 73 years (45.6±12.2 years) with recurrent cardiac valve disease underwent valve replacement. Duration between reoperation and former surgery was 3 months to 25 years (17.3±8.1 years). The reasons for reoperation included mitral valve restenosis after closed mitral commisurotomy (143 cases), valve restenosis and/or insufficiency after mitral or aortic valvuloplasty (53 cases), bioprosthetic valve decline (32 cases), perivalvular leakage (26 cases), other valve diseases after primary valve replacement (21 cases), infective endocarditis after valve replacement, valvuloplasty and repair of ventricular septal defect (24 cases), tricuspid insufficiency after repair of Ebstein’s anomaly (15 cases), prosthetic valve obstruction (9 cases), mitral or tricuspid insufficiency after repair of congenital heart disease (6 cases), and mitral valve restenosis after percutaneous balloon mitral valvuloplasty (2 cases). Reoperations included mitral valve replacement, aortic valve replacement, aortic and mitral valve replacement, tricuspid valve replacement, repair of perivalvular leakage, and valvuloplasty. RESULTS: Four patients died during surgery and 23 patients died during the early postoperative stage. The main causes of early-stage deaths were low cardiac output syndrome, ventricular arrhythmia, multiple organ dysfunction failure, left ventricle rupture, infective endocarditis and renal failure. Three hundred and four patients recovered. Follow-up was performed in 259 patients and duration was from 6 months to 21 years (9.5±6.8 years). NYHA cardiac functional status I to II was found in 189 cases. CONCLUSION: Risk factors for reoperation for heart valve diseases include low preoperative cardiac function, dysfunction failure of important organs, emergency surgery, long-time aortic clamping and cardiopulmonary bypass. Good perioperative management and proper surgical procedures at the appropriate time would produce good results for reoperation for recurrent cardiac valve disease.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2010-05-20.通讯作者：易定华，教授，主要从事心血管疾病的外科治疗研究Email:yidh@fmmu.edu.cn 作者简介：陈文生，副教授，博士Email:chenws@fmmu.edu.cn
更新日期/Last Update: 2011-03-17